Darlene Bartilucci, MDPatient Forms

Welcome to Baptist Primary Care. To help expedite your first visit, we provide our health forms online so that you can print and complete them at your convenience. If you have any questions, please don’t hesitate to contact our office staff.

Authorizes Baptist Primary Care to release information concerning the status of your health care, including laboratory and radiology results and to discuss your treatment plan with an individual that you name.

This link opens the official living will form provided by the Florida Agency for Health Care Administration. This form allows you to document your instructions to your doctor to provide, withhold or withdraw life-prolonging procedures.

This link opens the official designation of health care surrogate form provided by the Florida Agency for Health Care Administration. This form allows you to designate another individual to make treatment decisions on your behalf.

Requires Adobe® Acrobat Reader or Apple® Preview application. Click [ HERE ] to download and install the latest version of the Adobe® Acrobat Reader. Once you have the reader installed, you will be able to open and print the selected form.